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Bertumen JB, Pascopella L, Han E, Glenn-Finer R, Wong RJ, Chitnis A, Jaganath D, Jewell MP, Gounder P, McElroy S, Stockman L, Barry P. Expected vs Reported Chronic Hepatitis B Infection Cases in Persons with Active Tuberculosis - California, 2016-2020. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:728-732. [PMID: 38985652 DOI: 10.1097/phh.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Epidemiologic data regarding persons with active tuberculosis (TB) and chronic hepatitis B virus (cHBV) infection are limited because of lack of routine surveillance of cHBV in persons with TB. Potential underdiagnosis of cHBV in California among those with TB is concerning. We matched TB and cHBV registries to identify cHBV infections among persons diagnosed with TB during 2016-2020 and described their demographic characteristics. We calculated expected cHBV cases among persons with TB for each demographic characteristic using published cHBV prevalence estimates for the locations of birth for persons with TB. Estimates were from general or emigrant adult and teen populations. Reported cHBV infection among persons with TB were 23% lower than expected, particularly among Asian persons, persons living in the two healthiest Healthy Places Index quartiles, and residents of less populated jurisdictions in California. Results show the possibility exists for underdiagnosis of cHBV in persons with TB in California.
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Affiliation(s)
- J Bradford Bertumen
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Bertumen); California Department of Public Health, Richmond, California (Drs Bertumen and Pascopella, Mss Han and Glenn-Finer, Dr McElroy, Ms Stockman, and Dr Barry); Stanford University School of Medicine, Palo Alto, California (Dr Wong); Alameda County Public Health Department, San Leandro, California (Dr Chitnis); University of California, San Francisco School of Medicine, San Francisco, California (Dr Jaganath); and Los Angeles County Public Health Department, Los Angeles, California (Ms Jewell and Dr Gounder)
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Bertumen JB, Pascopella L, Han E, Glenn-Finer R, Wong RJ, Chitnis A, Jaganath D, Jewell M, Gounder P, McElroy S, Stockman L, Barry P. Epidemiology and Treatment Outcomes of Tuberculosis With Chronic Hepatitis B Infection-California, 2016-2020. Clin Infect Dis 2024; 79:223-232. [PMID: 38531668 DOI: 10.1093/cid/ciae169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Improved epidemiologic and treatment data for active tuberculosis (TB) with chronic hepatitis B virus (cHBV) infection might inform and encourage screening and vaccination programs focused on persons at risk of having both conditions. METHODS We matched the California Department of Public Health TB registry during 2016-2020 to the cHBV registry using probabilistic matching algorithms. We used chi-square analysis to compare the characteristics of persons with TB and cHBV with those with TB only. We compared TB treatment outcomes between these groups using modified Poisson regression models. We calculated the time between reporting of TB and cHBV diagnoses for those with both conditions. RESULTS We identified 8435 persons with TB, including 316 (3.7%) with cHBV. Among persons with TB and cHBV, 256 (81.0%) were non-US-born Asian versus 4186 (51.6%) with TB only (P < .0001). End-stage renal disease (26 [8.2%] vs 322 [4.0%]; P < .001) and HIV (21 [6.7%] vs 247 [3.0%]; P = .02) were more frequent among those with TB and cHBV compared with those with TB only. Among those with both conditions, 35 (11.1%) had TB diagnosed >60 days before cHBV (median, 363 days) and 220 (69.6%) had TB diagnosed >60 days after cHBV (median, 3411 days). CONCLUSIONS Persons with TB and cHBV were found more frequently in certain groups compared with TB only, and infrequently had their conditions diagnosed together. This highlights an opportunity to improve screening and treatment of TB and cHBV in those at high risk for coinfection.
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Affiliation(s)
- J Bradford Bertumen
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia, USA
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, USA
| | - Lisa Pascopella
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, USA
| | - Emily Han
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, USA
| | - Rosie Glenn-Finer
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, USA
| | - Robert J Wong
- Stanford University School of Medicine, Department of Medicine/Gastroenterology and Hepatology, Palo Alto, California, USA
| | - Amit Chitnis
- Alameda County Public Health Department, Tuberculosis Section/Division of Communicable Disease Control and Prevention, San Leandro, California, USA
| | - Devan Jaganath
- University of California, San Francisco School of Medicine, Center for Tuberculosis, San Francisco, California, USA
| | - Mirna Jewell
- Los Angeles County Public Health Department, Communicable Disease Control and Prevention Division, Los Angeles, California, USA
| | - Prabhu Gounder
- Los Angeles County Public Health Department, Communicable Disease Control and Prevention Division, Los Angeles, California, USA
| | - Sara McElroy
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, USA
| | - Lauren Stockman
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, USA
| | - Pennan Barry
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, USA
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Ku JH, Fischer H, Qian LX, Li K, Skarbinski J, Shaw S, Bruxvoort KJ, Lewin BJ, Spence BC, Tartof SY. Latent Tuberculosis Infection Testing Practices in a Large US Integrated Healthcare System. Clin Infect Dis 2024; 78:1304-1312. [PMID: 38207124 PMCID: PMC11093665 DOI: 10.1093/cid/ciae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a public health threat, with >80% of active TB in the United States occurring due to reactivation of latent TB infection (LTBI). We may be underscreening those with high risk for LTBI and overtesting those at lower risk. A better understanding of gaps in current LTBI testing practices in relation to LTBI test positivity is needed. METHODS This study, conducted between 1 January 2008 and 31 December 2019 at Kaiser Permanente Southern California, included individuals aged ≥18 years without a history of active TB. We examined factors associated with LTBI testing and LTBI positivity. RESULTS Among 3 816 884 adults (52% female, 37% White, 37% Hispanic, mean age 43.5 years [standard deviation, 16.1]), 706 367 (19%) were tested for LTBI, among whom 60 393 (9%) had ≥1 positive result. Among 1 211 971 individuals who met ≥1 screening criteria for LTBI, 210 025 (17%) were tested for LTBI. Factors associated with higher adjusted odds of testing positive included male sex (1.32; 95% confidence interval, 1.30-1.35), Asian/Pacific Islander (2.78, 2.68-2.88), current smoking (1.24, 1.20-1.28), diabetes (1.13, 1.09-1.16), hepatitis B (1.45, 1.34-1.57), hepatitis C (1.54, 1.44-1.66), and birth in a country with an elevated TB rate (3.40, 3.31-3.49). Despite being risk factors for testing positive for LTBI, none of these factors were associated with higher odds of LTBI testing. CONCLUSIONS Current LTBI testing practices may be missing individuals at high risk of LTBI. Additional work is needed to refine and implement screening guidelines that appropriately target testing for those at highest risk for LTBI.
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Affiliation(s)
- Jennifer H Ku
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Heidi Fischer
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lei X Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Kris Li
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sally Shaw
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Katia J Bruxvoort
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bruno J Lewin
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Brigitte C Spence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Sara Y Tartof
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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Li D, Tang SY, Lei S, Xie HB, Li LQ. A nomogram for predicting mortality of patients initially diagnosed with primary pulmonary tuberculosis in Hunan province, China: a retrospective study. Front Cell Infect Microbiol 2023; 13:1179369. [PMID: 37333854 PMCID: PMC10272565 DOI: 10.3389/fcimb.2023.1179369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
Objective According to the Global Tuberculosis Report for three consecutive years, tuberculosis (TB) is the second leading infectious killer. Primary pulmonary tuberculosis (PTB) leads to the highest mortality among TB diseases. Regretfully, no previous studies targeted the PTB of a specific type or in a specific course, so models established in previous studies cannot be accurately feasible for clinical treatments. This study aimed to construct a nomogram prognostic model to quickly recognize death-related risk factors in patients initially diagnosed with PTB to intervene and treat high-risk patients as early as possible in the clinic to reduce mortality. Methods We retrospectively analyzed the clinical data of 1,809 in-hospital patients initially diagnosed with primary PTB at Hunan Chest Hospital from January 1, 2019, to December 31, 2019. Binary logistic regression analysis was used to identify the risk factors. A nomogram prognostic model for mortality prediction was constructed using R software and was validated using a validation set. Results Univariate and multivariate logistic regression analyses revealed that drinking, hepatitis B virus (HBV), body mass index (BMI), age, albumin (ALB), and hemoglobin (Hb) were six independent predictors of death in in-hospital patients initially diagnosed with primary PTB. Based on these predictors, a nomogram prognostic model was established with high prediction accuracy, of which the area under the curve (AUC) was 0.881 (95% confidence interval [Cl]: 0.777-0.847), the sensitivity was 84.7%, and the specificity was 77.7%.Internal and external validations confirmed that the constructed model fit the real situation well. Conclusion The constructed nomogram prognostic model can recognize risk factors and accurately predict the mortality of patients initially diagnosed with primary PTB. This is expected to guide early clinical intervention and treatment for high-risk patients.
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Affiliation(s)
- Dan Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- College of Applied Technology, Hunan Open University, Changsha, Hunan, China
| | - Si-Yuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Sheng Lei
- Interventional Radiology Center, Hunan Chest Hospital, Changsha, Hunan, China
| | - He-Bin Xie
- Department of Drug Clinical Trial Institutions, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| | - Lin-Qi Li
- School of Public Health, University of South China, Hengyang, China
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Screening Practices for Latent Tuberculosis Infection in Clinical Trials Evaluating Treatments for Chronic Hepatitis B Virus Infection. J Immigr Minor Health 2022; 24:1594-1598. [DOI: 10.1007/s10903-022-01364-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
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